In RSI, what is the main purpose of avoiding ventilation between induction and paralysis?

• A. Ventilation
• B. Suctioning
• C. Monitoring of oxygen saturation.
• D. Preoxygenation.

Answer: (A)

During rapid sequence intubation, the goal is to secure the airway with minimal risk of aspiration. If you ventilate between induction and paralysis, positive-pressure breaths can inflate the stomach, especially since gag and airway reflexes are blunted once induction is given. This increases intra-gastric pressure and the chance of regurgitation and aspiration once paralysis is complete and the patient relies on the endotracheal tube for airway protection. By avoiding ventilation in this brief window, you reduce the likelihood of pushing gastric contents upward and maintain a safer course until the airway is definitively secured. Preoxygenation beforehand provides an oxygen reserve to tolerate the short apnea, while suctioning and continuous oxygen saturation monitoring support safety, but they don’t address the primary aspiration risk minimized by not ventilating.